Checking in and checking up

It has been way too long since I have written here. Much has happened or changed, even though right now I feel like I'm treading water.

Leading with the hips was good advice. I still follow it. I still have to tell myself, though, consciously. My physical therapist says I am walking much better, my back is straighter, and my knees are "softening". He says they no longer bounce back when he presses down on them. It's been a long time, this straightening. Most people do not have to spend so much time doing this. On the other hand, my therapist told me of another woman who has not put the time in as I have and who is now bent over and whose knees are bent more than before. He compliments me on my persistence.

Hip pain is a distant memory. I never have it any more, either during the day or the night. My experience is much like others who have had this surgery. Easy and done.

My main complaint when I walk is lower back pain. This is largely because I still don't have the best posture, and I know my weight makes it worse as well. Nevertheless, I have walked across the Mackinac Bridge in Michigan two years running - that's five miles across, and last September was cold and windy - and while I did feel back pain it was not enough to deter me or even cause significant discomfort. I felt like I managed it better in 2014 than in 2013. Not as tired, not as hurt, even though I had not done much to get ready for it.

Still in therapy. Still working on getting my knees straight, but also working on my right shoulder. I developed a constant ache in my arm and finally went in to see what was up, got referred to the physical therapist again. Actually, this turned out to be a good thing, because Medicare was no longer paying for my leg therapy. The therapist was "carrying" me. I didn't want that to keep happening so now I go in for rotator cuff damage and the knees get thrown in, so to speak. The tendon is not torn, I am happy to say. At this point much of the pain has gone away. The therapy is working. It's a delicate area, though, and one must be careful not to put too much weight or strain on it too soon. I also am working on elbow damage, different from the rotator cuff.

What with the shoulder, knee, elbow, and hip work I am in the therapy office for 1-3/4 hours each time now, three times a week. I use weights, a roller thing, and eight machines and do a total of 23 different exercises.  I have a rubber band to use for shoulder exercises when I travel. I tell people I am working my way through all my joints. I sure hope that isn't actually true. I look forward to getting out of physical therapy.

It Varies

Since my juice fast, the sharp pains in my groin area have not returned. However, pain in my hip in general, the more generalized pain, has not been kind to me lately. Could be because I am trying out some new prepared foods and some have ingredients that are not helpful.

I have gone on hikes the last two Saturdays. The first Saturday I tried a new one that is on a dirt road and is two miles long. There are a couple of little hills, nothing big. Yet I found it took a lot out of me. I didn't have significant pain but my knees were tense, so I was not particularly enjoying it. I was still hurting the following Sunday all day.

The following Saturday I did one of my favorite short hikes: Stoneridge. This hike is not far from my house and involves climbing a small hill, affording views out over the city. It is a rocky dirt trail. The total distance is not long - I don't actually know how long - but it is steeper than the previous week's hike. I had a good time on this hike and did not feel any aftereffects on Sunday. I'm not sure what I learned here. It may simply be that I need to take my time, as I had to climbing those rocks. Others sail over this trail, run it. I'll never do that but maybe I'll speed up a little over time.

One Year

It has been one year since my second knee surgery. It seems hard to believe that I have been in therapy for that long! On the other hand, it really has been getting old. Yet I plug through the routine three times a week, occasionally upping the weights or number of reps.

It is frustrating to me that my hip pain causes me to limp sometimes. Others usually attribute this to my knees, and I feel like a broken record saying "no, not my knees, my hip", and having to explain that yes, I see hip surgery in my future. I bore myself just getting the basic info out.

I was at the gym today for an Aqua class, but the class was canceled because not enough people showed up. It was raining, and rain tends to keep a lot of people away. I went upstairs to the weight machines instead. I did fifteen minutes on the bike, six on the elliptical, and fifteen on the treadmill. I devise my own little intervals on the treadmill, upping the level three or for decimal points for thirty to sixty seconds, then upping it again, and then taking it down twice. I do that a few times during the total fifteen minutes. I felt mild discomfort in my hip when on the treadmill today, but nothing I could call pain. That's an improvement over when I first took to the treadmill some months ago.

After doing the above cardio exercises I did several exercises on machines, strengthening my upper body, core, and back. I think I should head for the gym after physical therapy M,W, and F, to fill out the workout with these upper bod and core exercises. Making for an all-around effort.

At times I do wonder if I will ever see that light at the end of the tunnel. Did I mention in my last post that other clients at physical therapy have told me they suddenly hit the straight leg? That after a long time working on it, their knee finally went straight and there was no more pain? God, I want that so much. Will I be that fortunate?

I continue to take meds for restless leg syndrome and a recurring rash, but nothing else most of the time. Sometimes my leg (usually the right) aches to the degree that I cannot sleep and I end up taking some sort of pain killer, usually tylenol. Just to take the edge off. Sometimes I resort to Tylenol PM when it looks like it's going to be a LONG night. But I don't make a habit of it.

I have been doing a lot more work with photography in the last many months, partly because I upgraded my camera. But one difficulty I have faced is that photography field trips offered by photo groups in the area tend to involve standing and walking and not much chance to sit. Depending on how my hip is doing this can be quite a problem. I brought a "shooting stick" - also called a seat stick or something like that - to an outing at the Oceano Dunes not long ago. I found it a bit difficult to put the stick in the sand and lean against the seat, though. Other places should not present as much of a problem. Photography is usually a physically demanding activity for those who are really good at it. Well, sigh. I am doing better than I was before surgery. That is the point.

One year down. What will I say next year?

I did it!

Today another milestone. I did my first hike since the first knee surgery last April. In fact, it was probably well before April when I last hiked. I was hurting so much that hikes were far from appealing at the time I first went under the knife.

I chose the Elfin Forest in Los Osos for my first foray. The walk is almost entirely boardwalk, with many benches, and is only 4/5 mile long. It is not flat but the ascent is not steep, as it is very near the bay. Next to it, in fact. The picture above shows how it got its name. It really looks magical inside the tree cover. A separate little boardwalk enters the forest in specific locations so we can look but not touch. You could walk the whole way on the boardwalk and not know the wonders inside. But there is much to enjoy outside of the forest itself, in the views of Morro Rock and several of the "Seven Sisters" - ancient volcanos that line up, marching from Morro Bay to San Luis Obispo and actually into a part of San Luis Obispo.

But I digress. I went without a cane. I remember the last time I visited this little walk. It was well before my knee surgery. I grabbed at almost every chance to sit on one of the benches, to relieve the pain. This time I did not sit down once. I did not feel I had to. I did feel a bit of a strain toward the end but it seemed mostly because my body is not used to walking any more, not because of pain. My left knee did get a bit sensitive but it recovered all right. For a bit I thought I might need to ice my knees when I got home but I was fine by then, and am still fine now.

I could feel the pressure I was putting on my knees. It was a bit uncomfortable but not painful. I feel like I pushed them as far as they want to go right now, but I could go a bit farther next time out. I did not experience any hip pain.

This post does not reflect well how great I felt when I finished. Just yesterday I was making my way around Costco and finding it quite uncomfortable, both inside and out. I did not see how I could do a hike comfortably. Now I know that I can, and it's exhilarating.

Getting There is Half the Fun

I went to Aqua again this morning and to therapy in the afternoon. In therapy, the intern worked on the capsule a bit, then we worked on straightening again, to little effect. Paul then brought in a blood pressure cuff, pumped it up, and put it under my leg. When I pressed down we could see the amount of pressure I applied. I got up to six pounds of pressure. Then he used it on the right ("good") leg and I did ten pounds on there. When it got back to the left knee I was pressing about eight, as I recall. Later, at the end of my time there, I got the stim machine on again and was again pressing ten seconds, resting ten seconds, for however long it was set.

Work on the flex showed that I am clearly up to 120 degrees, which compares to 125 degrees on the right leg, and is a functional number. I may not get much past that - but I'd like to.

I then did some step-ups, which were similar to what I do on the stairs outside every day, but which did not require that I use my left leg entirely to raise my right leg. I could let my right leg do part of the work, spring off some. The intern noticed that I was working on perfecting the move, that I was actually "enjoying" it. I guess I was. I then did leg extensions, using a machine, and leg curls on another. All strengthening work. From there to the bike for 15 minutes, then some calf stretches, and finally the stim machine.

I have come to expect a couple of things from therapy: one is at least a portion of the time I will be dealing with fairly intense pain. Another is I expect to be corrected on form and alignment. I didn't get as much pain this time and I was focusing on alignment myself so perhaps I was doing a decent job. In any case, I have to take full responsibility for form and alignment all the time now. I do not want to slip. I find myself looking for my reflection when I can to see if I am doing things correctly.  More and more it's on me to do this right.

I honestly don't look forward to being set entirely free. I believe I have three more weeks with Paul and that's going to be that. However, I can extend the work on my own if I learn what I can do at the gym. I really want to have a good plan for afterwards, working with Clara at the gym.  I have not had a chance to discuss this with Paul, but I started to bring it up with his intern. I'll try to remember to bring it up at the start of the next session.

I Feel Good! Like I Knew I Would!

Life for me is a series of ups and downs. I expect it's that way for most people. Today I'm on a high and I did not want to miss reporting it.

I went to the gym this morning and did 20 minutes on the bike, working the resistance up to where I was getting a heart rate of 125 beats per minute. At the physical therapy office yesterday the goal was to reach the level of work that would get me to 120 beats per minute and I wasn't entirely sure what that felt like. I think I've got it now. My knee felt a slight strain with every turn on the bike, which suggests to me that it was working the flex just a bit, which is a good thing.

After the bike I did two sets of ten on the leg press, with 140 pounds. I think I can start to bend my knees more on the leg press. Trouble is, with the Nautilus machine I have to bend to the max when I first get on it. I'd like a different design, please.

The leg press at the gym is similar to this.

After the leg press I moved to the hip abductor-adductor machine, to do abductor work. This is similar to the clamshells I am supposed to do at home but with both knees at once so I don't think I can eliminate the clams, unfortunately. Still, I like this machine so I use it.

And that was it for the gym today. Light workout. Which is good. We need to work up to some things. After spending a few minutes in the steam room and taking a shower and getting dressed, I headed over to Trader Joe's for a few groceries, and then to Roxanne's Birkenstocks in the hopes of finding yet another identical pair of shoes to the Earth shoes I wear all the time. Well. Earth shoes no longer makes exactly that pair and what they do make that is similar was not in stock. Poor me. I ordered the replacement shoes. Also admired some new sandals that are built to be easier on your feet and look good. But they did not have any in my size, of course. 

Back home then, to put the groceries away. And to revel in this feeling of Good. When I get in and out of the car now I no longer feel any pain in my knee because I have achieved a high enough level of flex. I can now walk down stairs one foot at a time (no two-stepping).  I was able to go from the gym to Trader Joe's to downtown without feeling worn out. These things are terrific achievements for me. Finally I am seeing real change and loving it. 

I worked hard at achieving change without getting knee surgery and I was only able to get to a certain point and stay pretty much level after that. I am now making noticeable changes week by week and it is just wonderful. At least that's how it feels right now.

It's Paying Off

I had a three-day break from physical therapy. Frankly, I don't like that. I want as few days as possible between these visits so I don't slip.

Nevertheless, I do try to use the time reasonably well and to focus on every move I make. Thus my little walks around the small block I live on and to the mailbox take a bit of time because I am telling myself lift heel and toe, watch alignment, stomach in, stay tall - with every step. And take small steps. Moving is not a problem for me. Moving correctly is.

Inside the house, too, every time I get up I think of alignment, stomach, weight on inside of foot...walking down the hall has become a regular journey, a challenging journey, every time. I have to stop myself from just "going" and go deliberately wherever I go.

In addition to the focus on walking I am of course continuing stretch exercises and doing some specific leg lifting efforts whenever I go into the bathroom. I have a whole repertoire now and I am doing one thing or another in between whatever other business or home activity I need to do. I know that I could do more. I have to give myself credit for doing, though.

The physical therapist finally arrived this afternoon and, among other things, he wanted to see me walk with and without my cane. And he said I am moving much much better than I was last week. When we got to the extension work I had not gained any degrees, sad to say (actually lost, because the goal is zero), but my leg seems straighter in general than it has been. The work is paying off.

No Longer a Matter of If, but When

I met with a surgeon Feb. 23. He took more x-rays and told me that my left knee is plumb wore out (not in exactly those words). He said surgery should have been done several years ago. Not only is the cartilage gone but there are bone spurs all over the joint. When I asked if there were specific exercises I could do before surgery he said not really, ride a stationary bike if you can, do some leg lifts, but until those bone spurs are gone there is not much to be done.

He asked when I wanted it done and I said as soon as possible. But when I got home and started thinking about it I realized that I had not taken all things Medicare into account. I learned that hospital coverage ("part B") does not cover the doctor's costs - or, in fact, the anesthesiologist's. I would have to pay 20% of those costs in addition to a "hospital deductible". There is a difference between in-patient and out-patient status as well, so the transitional care might also require a 20% co-payment. I got to thinking that maybe I need a Medicare supplement after all.

I hunted around and found a supplement that looks right for me and signed up. As I understood what I read, this first surgery would not be covered if I have it done right away. I will probably have to wait a few months. I am going to call the agency tomorrow to find out if I read that right.

I am definitely having this surgery. My knees are too far gone for any other program to help them now. The surgery will be "minimally invasive" so I should be on my feet the day of the surgery, which is a relief.

Obviously this changes this blog. I really wanted to manage this arthritis without surgery but it has become so disabling that I am accepting the need. I am continuing to go to the gym because I am sure that the more flexible and strong I am the better.

Pushing through

I have had lower back pain for the past several days. I get back pain now and then but usually it only lasts a day. Not this time. It is hard to do things when my back hurts, needless to say.

This morning I woke with back pain again but it was a little less. My legs, though, were doing worse. It was very painful straightening my legs out for some of my morning exercises. But, as usual, it helped a little just to do them. I found my way to the couch and my computer finally and thought I would do all right. Then I got up to get ready for Aqua class and a sharp pain hit my left calf, from knee on down. It was excruciating. I limped to the counter, which I grabbed, and considered not going to class. I could hardly walk.

The pain was so intense I decided to take an acetaminophen and codeine tablet. Just one. I can sometimes avoid nausea if I take just one. It was soon after that I got my stuff together for Aqua. During the class there were many times my knees and calves hurt, but it was manageable. I could not tell if the pain reliever made a difference or not. Just moving helped.

Lately I realize that I go to the gym more for day-to-day living than for longer-term goals. I find that the exercises help loosen me up a little, make me a little stronger, help me through the day. I know when I go that I will likely leave the gym feeling a little better than when I arrived. It's enough of a reason. And so it was today. I was able to go to the store and do a little shopping without much pain.

Having pain, even these bouts of extreme, burning pain, is not enough of a reason to avoid exercise. Especially because the exercise can help and rarely makes it worse.

Cool in the Pool

I live in a place that has a mild climate. Rarely does the temperature dip below 60 degrees F during the day. But there is wind, and in an outdoor pool a temperature of 60 and a bit of wind can make for a chilly experience.

Monday was the first day I really felt it. We were moving actively, as we always are in Aqua class, yet every time my shoulders were outside the water I felt the chill, the goosebumps, on my arms. The water was warm then, however, so it was nice to stay as much under it as possible.

Today it was perhaps chillier and the water was not particularly warm. Probably warm enough for a summer day but not so much for right now. I heard different stories about this: 1)  that usually the pool gets cranked up a bit in the winter but perhaps the staff was caught unawares by the sudden temperature drop; and 2) the pool heater is broken and needs to be fixed.  I could buy either one of those. This is a nice gym but some things are neglected, obvious things, which I don't know if I will ever understand. Could be just a lack of consistent management or a real maintenance plan.

Barb, the cheerleader, was our leader today. She is the queen of the intervals and today she was really into that, to keep us warm. For example: We twisted, suspended (no feet on the pool bottom), as fast as we could, for these intervals:

30 sec, 15 sec break
45 sec, 15 sec break
60 sec, 15 sec break
60 sec, 15 sec break
45 sec, 15 sec break
30 sec, 10 sec break
60 sec, 5 sec break
45 sec, 5 sec break
30 sec

The "breaks" were times we put our feet down and usually did jacks instead of twists.  Following these intervals, we did five minutes of kicks, noodles under our arms and legs extended in front of us, kicks from the hip, alternating flexed and pointed feet. Five minutes is a LONG time doing that.  We did several other activities in intense concentration as well. I will say it did get us warm, as warm as possible given we were not entirely under water. When we "bicycled" in the water with our hands in the air our hands froze. I was reminded of that commercial: "I can't feel my feet!"

There is another class member who always wears a wetsuit top that covers her head as well as part of her face, plus a hat on top. She is practically unrecognizable out of the water. I asked her about her outfit and she said she was still cold but that she had tested the top by not wearing it one time and there is a big difference. She said it is very worth the cost. So I am seriously thinking I'll get me one before the next Aqua class.

The good thing is that all this activity, which really was not different from an average aqua class with Barb, just colder, did seem to be good for my joints. I was able to go to a market and do a little shopping without pain. And now I am moving around the house all right. Much different from yesterday.

Up From Pain and Slipping at Times

After my few days of unusually bad pain  I went back to a "normal" that isn't so bad. I have managed to get around without a whole lot of pain, my times on the treadmill have generally not included pain, I have felt well enough to get up and do some cleaning and shopping. Not all wonderful but better.

There are times that I do slip from the path. Last night, for example, I just watched television and did not do my nighttime exercises. If I do not get them done earlier in the evening chances are I will not do them at all. I forgive myself. I am human. It doesn't happen often.

Also, yesterday morning I got started later than usual and skipped the resistance band exercises at the gym, along with the left arm stretches with the wooden stick. These are all exercises that I could skip one day a week, really, considering that I do similar moves in Aqua and that my arms and shoulders are doing much better than my knees and hip. I planned to pull out the bands at home and do them after sewing class anyway, but I didn't do it.

This blog is as much a confessional as a record of pain and progress. I am not looking for advice unless it relates to what I am doing. I am not looking for cheerleaders or coaches, telling me to buck up, get going, don't ever skip an exercise. I know what I need to do and I am doing it. If sometimes I slip that does not mean I need anyone standing over me reminding me that I need to keep this up. Do I not know that?

Pain Days

For the last few days I have had more pain in my knees and my feet. Not in my hip, fortunately. When I wake in the mornings and do the bed exercises I find the first ones quite painful because I am so stiff and in pain.

Today I felt like skipping the gym and I think I could have justified it, but I know that, as they say, that way lies disaster. I can miss a day now and then but I have to get back to it quickly.

Here's the thing with me: I don't seem to develop habits. Good habits, that is. I have the habit of reading my life away. I have the habit of eating when I watch television. But when it comes to things like brushing teeth or doing exercises I have to decide every single day to do them. It doesn't happen automatically. So if I miss several days in a row I'm surely in danger of missing a lot more. Today I felt sluggish and in pain and I had to talk my way through the fifteen minutes on the bike, but I knew I had to get through it. I have learned that it is important not to give in to those bad feelings too often.

Consumer Reports Agrees with Me (generally)

I got an email from Consumer Reports Health today, that included a blurb about knee arthritis. It said exercise helps knee arthritis but the jury is still out on whether it helps hip arthritis. I went to the site to read the whole article and discovered that I have to subscribe to that particular division of Consumer Reports to read it. I had not subscribed before ($19 a year) because it seemed the health advice was similar to what is reported elsewhere.

However, Consumer Reports has no ties to any commercial interest. Along with Best Pills, Worst Pills, then (a division of Public Citizen, an old respected consumer organization), it is a source that can be trusted, as far as it goes. So I went ahead and subscribed today.

In part, the article notes:

Do they work?

Yes. If you have osteoarthritis of the knee, exercise can reduce your pain and disability and help you lead a more normal life. We're not sure how well it works for osteoarthritis of the hip.

Other physical therapies, including applying superficial and deep heat or applying ice, are popular for dealing with osteoarthritis. But there isn't any good evidence that these treatments help, although they might make your joint feel better for a short time.

What are they?

Exercise for osteoarthritis can be either general exercises for your whole body, like walking, swimming or aerobic exercises, or it can be specific exercises for the joint that is troubling you. The best specific exercises for the knee may be those that strengthen the muscle at the front of the thigh.

There are many different exercises that may help your osteoarthritis. You should discuss what might work best for you with your doctor or a physical therapist. An exercise program may include strengthening and stretching exercises.

The article then offers a couple of examples of exercises that help:

Knee exercises

These are strengthening exercises for the muscles at the front of your thighs. In one exercise, you lift your leg straight up in the air. You do 200 of these straight leg-raises a day. Your knee joint doesn't actually move, but you strengthen the muscles that support it.

Resistance exercise

You lie flat and lift your heel straight up until it's 12 inches off the ground. You bend your foot up and down and side to side in a T shape, and you repeat this pattern three times.

Resistance exercise may help your osteoarthritis.

You may then move on to an exercise in which you stand against a wall and slide so your knee is bent to 30 degrees. You hold this for 10 seconds to 15 seconds and repeat three times.

General aerobic exercise

This form of exercise is designed to make you more fit overall. It improves the ability of your heart to pump blood around your body and the ability of your lungs to take in air. It can help you lose weight and feel good about yourself. Aerobic exercise should increase your heart rate (your pulse).

These exercises are similar to (but not identical to) some that I do every day.

The web page includes the evidence, something I am always wanting. I can look up the actual studies and the conclusions.

Lately I have become a little discouraged and have even missed one day of Aqua and part of my evening exercise routine. But I am calling that a break and moving on, fully charged. There is no sense in regretting what I have not done, because it is past. My next goal is to pull together all of the pieces and describe here exactly what my routines include now. At times I forget myself!

A Fourth Meeting with Clara

On Thursday, October 7, I met with Clara again. Clara is the trainer at the gym who has been helping me build my strength where I need it to counteract the effects of arthritis. I showed her the new exercises given me by Paul, the physical therapist, and I told her that overall I felt I was at a higher level, experiencing less pain in general, than I was when we first met in April of this year.  We went upstairs to the weight room area.

She showed me a machine where I could the new hip exercises, using a band around my ankle and weights.

We discussed the sitting and standing routine, and decided I could do that on the high box that sits in the weight room area. I can also sit on that box to do the raising and lowering of my leg, with ankle weights.  Unfortunately, the gym does not have ankle weights so I will need to find mine and bring them with me.

Finally, I asked her about alternative ways to do some of the things I am doing already. She showed me a new way to do lat pulldowns, sitting on a large ball, thus efficiently working the sitting and standing muscles as well. I also learned how to do the compound row using a different machine.

I will continue to do the remaining exercises as before, except that I will alternate using the different machines for lat pulldowns and compound rows.

In the last few weeks I have lowered the weight on some things and raised it on others. I felt I needed to keep it down more on the leg press so that I could focus more on keeping my knees apart.

Since meeting with Clara I have done the new routine a few times. I found I rather enjoy using the new machines. They are a little different in how they work so they probably work my body a little differently, but also just manipulating different machines gives me more a feeling of mastery, and I am more likely to find machines I can use when I travel.

At this time I am doing the rising and lowering to a seat rather sporadically. I think I need to work in at least one time a day when I do that consciously, regularly. Similarly, I haven't gotten the sitting leg raises and curls with ankle weights in at all, because I haven't found my weights.

The visit with Clara took only a half-hour. We will meet again if I feel the need or after my next visit with Paul. So far this way of adjusting the routine is not turning out to be costly for me, which I appreciate. I don't need anyone holding my hand or walking me through the routines regularly, as I can pick up and do them myself. I can also adjust as recommended.

Right Foot Pain

For the last few days I have been happy to adjust my walk by putting my weight on my heel, then moving to my big toe and the big toe "knuckle".  Most of the time this means I walk deliberately and perhaps a little slower but the pain is less than it was. Or at least it seems that way.

This morning I woke with pain in my right foot. I managed to get down the hall to feed the cats but the pain was hard to manage and did not get better. By the time I finished my morning exercises (on my bed) and brushed my teeth and got dressed, the pain had subsided some, and my foot did not seem too bad by the time I got to the gym. However, it surged again on my way out the door and as I prepared for sewing class. It was with me throughout the class, causing me to limp to some extent. I still tried to walk the right way but I was not rewarded with less pain.

The pain is on the right side of my foot, toward the heel but in front of the ankle, and radiates through that section, from bottom to top. The top seems to be the most painful.  When I point my toe the pain worsens.  I haven't found a position that takes the pain away. I might even indulge in some tylenol for the first time in quite a while. 

At the gym I did not do my usual five and a half minutes on the treadmill, because no treadmills were available each time I looked. So I do not know if walking on it would have helped or hurt.

Learning to Walk Again, and Other Stories

not my knees but they could be

I have been trying to put my finger on what especially disappointed me about my last visit to the physical therapist. Paul answered any questions I had but I did not know what to ask, perhaps. As I thought about it later I realized I wanted more of a "test". I wanted to know more about what I have accomplished, and the tools at Paul's disposal would not really give me that. I have thought about this some more and figure eventually I will get a complete physical, or at any rate a near-complete one, perhaps when I first can start on Medicare, which is next January.  That won't tell me where I've been but it will provide a marker for the future.

In the meantime I have been trying to work in the new Paul exercises. I haven't done all of them yet even and I haven't worked out when I will do them or how often. I am thinking I'll blend them with my morning routine eventually, but I will also fit some in throughout the day.

One of the new exercises is the rising from a chair one, without hands. I have been doing that somewhat randomly, as it occurs to me and when I am in the right frame to do it. I have found that if I have been sitting for a while it is going to be too painful. So when I am near a higher chair or the bed I try it then, a few times up and down.  This is going to be tremendously important as time goes on. As I am better able to rise and sit without hands my life is going to be different, better.

Similarly walking. I have been trying to focus on my steps every time I walk now. At first it was awkward but it is getting easier and it seems to be causing me less pain. I sometimes think of myself and "my new legs", feeling such hope that as I adjust my gait the pain will gradually lessen and again my life will be better.

None of it is instant. Wouldn't it be wonderful if Paul said, "Have you tried X?" and I try it and say, "Wow!! I can walk without pain now!" No instant therapy here. Yet I feel these latest exercises are coming closer to what will really help and I will see a difference, I will be able to tell maybe in a month.

Second Time with the Physical Therapist

This morning I met with Paul, the physical therapist, for the second time. It has been about two and a half months since we last met. I hoped to see clear positive changes from the work I've been doing.

There were some, but they are small. I should have expected that because Paul said it would take a long time for changes to be measurable. The positive changes were in the range of motion for my knees. They have both increased. There may have been improvement in other areas as well, but not as measurable. The alignment of my knees is just about the same. As Paul said, "It's not worse!", which is true.

I felt a little deflated that there wasn't some huge improvement that was magically measurable. But we moved into additional areas and I see some real potential for improvement here:

* Paul showed me how I should be walking on my feet. I told him my feet felt off-balance and he watched me walk and showed me what I need to emphasize. I need to start with my heel and then move to my big toe and the "knuckle" of the foot. I have been walking more on the outside of my foot for so many years I can't remember any other way. As soon as I tried walking the right way it seemed that walking was less painful. It takes a bit more effort so I don't see this changing overnight. But now I am aware of specifically how to place my feet and this will make a difference.

* He showed me a "test" for rising from a chair. It involves rising from an 18"-high chair with arms crossed in front, continuously for 30 seconds. That is, seeing how many times one can rise from the chair in 30 seconds. I did it six times. The average for my age is about 12 - 15 times. So that's my goal, get to average. And to get there I will start out with higher seats and rise very slowly and lower very slowly. Honestly, I was surprised that I could get up that way at all! I think some of the exercises I have been doing have started to give me enough strength to do so, and I am very encouraged and even excited about this. Getting up from a seat without using my arms is something I have wanted to be able to do for a very long time.

He gave me more hip exercises that I can do with resistance bands, and something for my knee - unfortunately, we forgot to get me copies of that exercise. I will have to ask. Let me see if I can remember, though:

Sit on a high surface and place a weight on my ankle. Let it swing comfortably for a bit, then raise up and hold, then bend inward and hold. I think this one is to extend the range of motion of the knee.

My next step, then, is to make another appointment with Clara and discuss these new exercises with her so we can work out changes to the gym routine.

Glucosamine and Chondroitin are no help

From McDougall's newsletter Sept 2010:

Glucosamine and Chondroitin Do Not Help Arthritis

Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis by Simon Wandel, published in the September 22, 2010 issue of the British Medical Journal concluded, “Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.”¹ They went on to say, “Our network meta-analysis of all 10 available large scale patient blind randomised trials in 3803 patients with knee or hip osteoarthritis showed no clinically relevant effect of chondroitin, glucosamine, or their combination on perceived joint pain.”

Comment: The most common form of arthritis afflicting humans is osteoarthritis, often referred to as degenerative arthritis, because the joints slowly deteriorate as a result of “normal wear and tear associated with aging.” Doctors commonly advise people to lose weight, especially if they have disease of the joints of the lower extremities, and to avoid prolonged and strenuous use of the affected joints. Non-steroidal anti-inflammatory drugs (NSAIDs), such as Motrin and Advil, are commonly taken for pain relief. Paradoxically, these NSAIDs also accelerate the loss of cartilage in the joints and delay bone healing.^2,3 This then worsens the osteoarthritis.

Taking cartilage constituents, such as glucosamine and chondroitin, has been recommended for osteoarthritis, and many studies support its use. In my April 2004 newsletter I recommended glucosamine for arthritis based on the research I had available then. However, in the past six years I can recall no patients telling me of pain relief or improved mobility that they have achieved from taking this cartilage supplement. Therefore, I am changing my recommendation. Because of the low cost and few side effects, you may still wish to do your own personal trial with glucosamine, but I can no longer tell you that I believe it is beneficial. (I reserve the right to change my opinions on all medications and supplements because the research is always changing and most of it cannot be trusted as reliable in the first place. In case you are wondering, I will not be changing my opinion on the best diet for you.) I have never recommended chondroitin because it is derived from cow cartilage. This cow matter may contain infectious microbes, such as those that have been found to cause mad cow disease.⁴

The overall benefits of a healthier diet and weight loss for osteoarthritis are well established.⁵ Three-hundred and sixteen older, overweight or obese, sedentary men and women with x-ray evidence of knee osteoarthritis were randomly assigned to one of four 18-month treatments: healthy lifestyle control, diet-induced weight loss, exercise, and diet plus exercise. Those who lost weight due to an improved diet showed a decrease in inflammation measured by a variety of tests. Exercise did not seem to make a positive difference in this study.

I recommend people with osteoarthritis take very good care of their diseased joints. This means in many cases that they should avoid certain exercise. Someone with disease of their hips, knees, or ankles should not be running, and maybe should limit their walking. Instead, exercise for them should be bicycling, swimming, and/or rowing. The best diet for weight loss and overall joint health is the McDougall diet.

1) Wandel S, J¸ni P, Tendal B, N¸esch E, Villiger PM, Welton NJ, Reichenbach S, Trelle S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis.BMJ. 2010 Sep 16;341:c4675. doi: 10.1136/bmj.c4675.

2) Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol. 2008 Jan;102(1):10-4.

3) Ding C, Cicuttini F, Jones G. Do NSAIDs affect longitudinal changes in knee cartilage volume and knee cartilage defects in older adults? Am J Med. 2009 Sep;122(9):836-42.

4) Mad cow disease and chondroitin sulfate. Harv Health Lett. 2001 May;26(7):3.

5) Nicklas BJ. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Am J Clin Nutr. 2004 Apr;79(4):544-51.

----------

The comments above are by Dr. McDougall. I notice that in his recommendations he says "exercise did not seem to have a positive effect in this study". Meaning exercise alone did not reduce pain. 

He goes on to recommend for and against certain types of exercise - swim, don't walk, for example. Take care of your joints.  And eat a low-fat vegan diet. I already eat a whole-foods vegan diet so do not believe that the inflammation in my joints comes from my food (I have done some limited tests). I do tend to stray from low-fat from time to time, sorry to say.

I think certain types of exercise can in fact reduce pain. But the exercises do need to be specific to the source of pain, which is the type that I am doing now. I have noticed some differences in the pain - both in the intensity and the length of time I am in pain, and I hope to find some specific changes when I go to the physical therapist tomorrow.

Moving ahead

This morning, at the gym, I felt no pain while on the treadmill, for the full five minutes. I still felt a little discomfort, stiffness, but it did not bother me. It was a short time and I did not want to tempt fate by staying on the treadmill longer, but it felt good.

Earlier I had felt more pain in my right knee than usual. Lately my knees have been sharing their pain with me more while my right hip offers less. I like to think of this as a kind of progress, because I think the overriding hip pain was blocking out the knee pain for so long, and now the hip pain is less, so the knees are coming back.

Tomorrow I have my second appointment with Paul, the physical therapist. I will see what progress I have made and I hope I will remember to ask about the resurgence of knee pain.

Getting the Strength Back

I was sick on my trip. The first three days I was too sick to even think about exercise (although I continued to do my PT* routines). Then I started feeling better and better. I drove home Wednesday, three days ago, and I am now working on getting back where I was. I've been back to the gym three times, twice doing my weight machine routine and once to an aqua class. I have backed off the weights for most machines both times, and even then I felt tired. But I did them! I keep remembering one tip from the Arthritis Foundation: keep on doing the exercises even when you don't feel tip-top. Thing is, we arthritis folks don't tend to feel tip-top a whole lot, or at least I don't. So if I let the little setbacks throw me I'd never get anywhere.

I came home to find my gimp placard in the mail. So I have been enjoying driving up to the front of the gym, not having to hike in from the farther reaches of the parking lot.



* PT: Physical Therapist - see this and this.